Prevalence of Chlamydia trachomatis endocervical infection in systemic lupus erythematosus patients and evaluation of the risk for HPV-induced lesions

Exploring bidirectional causal relationships between antibody-mediated immune responses to infectious agents and systemic lupus erythematosus through Mendelian randomization and meta-analyses

BACKGROUND

Previous investigations into the causal relationship between infections and systemic lupus erythematosus (SLE) have yielded controversial results. This study delves into the bidirectional causal relationships between various infectious agents and SLE, employing two-sample Mendelian randomization (MR) from an immunological perspective.

METHODS

Utilizing genome-wide association study (GWAS) data for 46 antibody-mediated immune responses (AMIRs) to 13 pathogens and three distinct SLE datasets, we employed Bayesian Weighted MR (BWMR) and inverse variance weighted (IVW) methods to ascertain causal links, supplemented by meta-analysis to resolve inconsistencies. Sensitivity was evaluated using complementary methodologies. Genes mapped by instrumental variables (IVs) of each significant phenotype were further analyzed using summary-data-based MR (SMR).

RESULTS

Meta-analysis of forward MR results suggested a protective role of elevated antibody levels against Epstein-Barr virus (EBV) antigens EBNA-1 (IVW: OR = 0.70, 95 % CI = 0.60-0.83, p < 0.001) and ZEBRA (IVW: OR = 0.72, 95 % CI = 0.53-0.97, p < 0.05) in SLE. Conversely, reverse MR indicated positive correlations between SLE and antibodies to Chlamydia trachomatis pGP3 (IVW: OR = 1.03, 95 % CI = 1.01-1.06, p < 0.01) and human herpesvirus 7 (HHV-7) U14 (IVW: OR = 1.03, 95 % CI = 1.01-1.06, p < 0.05), along with negative correlations with antibodies to Helicobacter pylori GroEL (IVW: OR = 0.96, 95 % CI = 0.92-0.99, p < 0.05), varicella-zoster virus (VZV) glycoproteins E and I (IVW: OR = 0.98, 95 % CI = 0.98-0.99, p < 0.001), and polyomavirus BKV IgG (IVW: OR = 0.92, 95 % CI = 0.88-0.95, p < 0.001). Additionally, SLE-associated genes were enriched in pathways such as the response to muramyl dipeptide (MDP), with seven genes showing significant causal relationships with AMIRs according to SMR analysis.

CONCLUSIONS

Our findings do not support that antibody response to infections increase the risk of SLE. Rather, SLE itself influences antibody response to infections. These insights provide a deeper understanding of the interplay between infectious pathogens and SLE and may guide future preventive and therapeutic strategies.

The serodiagnositic value of Chlamydia trachomatis antigens in antibody detection using luciferase immunosorbent assay

Introduction

Among the different antigens used in the detection of anti-Chlamydia trachomatis antibodies, significant differences in sensitivity and specificity have been observed. Further evaluation of C. trachomatis antigens in antibody detection is urgently needed for the development and application of C. trachomatis serologic assays.

Methods

Chlamydia trachomatis antigens Pgp3, TmeA, InaC, and HSP60 were selected and used in luciferase immunosorbent assay (LISA). The detection results obtained from well-defined C. trachomatis positive and negative samples were compared with the commercial C. trachomatis ELISA (Mikrogen) for performance evaluation.

Results

Pgp3, TmeA, InaC, and HSP60-based LISA showed sensitivity of 92.8, 88.8, 90.4, and 94.4%, and specificity of 99.2, 99.2, 99.2, and 92%, respectively. ROC analysis indicated that Pgp3-based LISA showed similar performance to Mikrogen ELISA (AUC 0.986 vs. 0.993, p = 0.207). Furthermore, four C. trachomatis antigens achieved strong diagnostic efficiency, i.e., positive likelihood ratios [+LR] ≥ 10 in C. trachomatis-infected women and negative likelihood ratios [-LR] ≤ 0.1 in C. trachomatis negative low exposure risk children, but only Pgp3 and TmeA showed strong diagnostic value in general adults. In addition, Pgp3, TmeA, and InaC, but not HSP60, achieved high performance, i.e., both positive predictive value (PPV) and negative predictive value (NPV) ≥ 90.9%, and showed no significant cross-reactivity with anti-Chlamydiapneumoniae.

Conclusion

Three C. trachomatis species-specific antigens Pgp3, TmeA, and InaC show superior performance in the detection of anti-C. trachomatis antibody, indicating the potential to be used in developing C. trachomatis serologic tests.

Association between systemic lupus erythematosus and risk of cervical atypia: A meta-analysis

BACKGROUND

Previous studies showed conflicting results regarding the association between systemic lupus erythematosus (SLE) and risk of cervical atypia. Therefore, the present study aimed to make a meta-analysis to summarize results of studies regarding association between SLE and risk of cervical atypia.

METHODS

We searched for articles published before March 2021 in in the following databases: PubMed, EMBASE, Web of Science, Medline and Google Scholar. Odds ratios (ORs) and relative risks (RRs) with their 95% confidence intervals (CIs) were computed to create a pooled effect size and 95% CI using STATA 12.0 software.

RESULTS

The present meta-analysis showed that SLE was significantly associated with increased risks of cervical atypia (OR/RR = 2.94, 95% CI 2.22 to 3.89, I² = 92.1%, p < .001), cervical cancer (OR/RR = 3.13, 95% CI 2.09 to 4.70, I² = 84.7%, p < .001), squamous intraepithelial lesion (SIL) (OR/RR = 5.00, 95% CI 2.58 to 9.69, I² = 88.9%, p < .001) and low-grade SIL (OR/RR = 3.14, 95% CI 1.29 to 7.67, I² = 63.3%, p = .018) with random effects models.

CONCLUSION

In summary, findings of this meta-analysis demonstrated that SLE was associated with a higher risk of cervical pre-malignant lesions and carcinoma. It may be necessary for clinicians to remind women with SLE to screen human papillomavirus infection and be vaccinated as soon as possible. However, caution is required when interpreting our findings. Further studies, especially well-designed randomized controlled clinical trials are awaited to confirm the association between SLE and cervical atypia-associated diseases.

[Human papillomavirus and systemic lupus erythematosus]

Infection with human papillomavirus (HPV) is one of the most widespread sexually transmitted diseases and the main risk factor for cervical cancer. Underlying conditions, like immunosuppression, favour the persistence and the progression of cervical lesions to an aggressive form. Patients with autoimmune diseases, and particularly systemic lupus erythematosus (SLE), may be prone to HPV infection and cervical dysplasia. However, the risk factors for developing persistent HPV-related infection, dysplasia and cancer are not identified for patients with SLE. The existence of an increased risk of cervical cancer compared to the general population remains debated. Thus, HPV vaccine is recommended for SLE patients as well as for the general population. Vaccine coverage of SLE patients is not known in France. Adolescents with chronic health condition seem to be insufficiently vaccinated regarding their vulnerability to infectious diseases. Strategies are required to decrease HPV vaccination barriers.

A review on SLE and malignancy

Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population. There is increasing evidence to suggest that patients with SLE have a slightly higher overall risk of malignancy. The risk of malignancy in SLE is of considerable interest because the immune and genetic pathways underlying the pathogenesis of SLE and the immunosuppressant drugs (ISDs) used in its management may mediate this altered risk. Our current understanding of these and other risk factors and the implications for treating SLE and screening for malignancy is still evolving. This review summarizes the association between SLE and malignancy. The first section discusses the risk of overall and site-specific malignancies in both adult- and pediatric-onset SLE. Next, we evaluate the risk factors and possible mechanisms underlying the link between malignancy and SLE, including the use of ISDs, presence of certain SLE-related autoantibodies, chronic immune dysregulation, environmental factors, and shared genetic susceptibility. Finally, we review guidelines regarding cancer screening and vaccination for human papilloma virus.